Provider Demographics
NPI:1831196534
Name:WEST, GUNNAR (DO)
Entity type:Individual
Prefix:
First Name:GUNNAR
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-1106
Mailing Address - Country:US
Mailing Address - Phone:214-330-7028
Mailing Address - Fax:214-330-8497
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:E121 BOX 26
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3000
Practice Address - Country:US
Practice Address - Phone:214-330-7028
Practice Address - Fax:214-330-8497
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5414207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112788801Medicaid
TX112788801Medicaid
TX00J90XMedicare ID - Type Unspecified